Hemophagocytic Lymphohistiocytosis Complicating T-Cell Lymphoma in a Patient with HIV Infection.

Hemophagocytic lymphohistiocytosis (HLH), while uncommon, may be a devastating complication of lymphoma and/or human immunodeficiency virus (HIV) infection. While several of the diagnostic criteria for HLH are relatively nonspecific, particularly in the setting of a systemic inflammatory response, more diagnostic specificity may be achieved with marked elevations in serum ferritin (e.g., >100,000 ng/mL). Increased suspicion of HLH, particularly in the setting of persistent, unexplained fevers, pancytopenia, and transaminitis, should prompt consideration of HLH. Earlier diagnosis and initiation of therapy have the potential to alter the natural history and poor prognosis of this disorder. We present a patient with HIV infection who developed relapsed T-cell lymphoma complicated by hemophagocytic lymphohistiocytosis.

Síndrome de Kawasaki. Persistencia de la fiebre luego del tratamiento / Kawasaki syndrome. Fever persistence after treatment

El síndrome de Kawasaki es un trastorno multisistémico, de etiología desconocida, que afecta a niños menores de 5 años. Presentamos el caso de un niño de 2 años con síndrome de Kawasaki, que recibió tratamiento con inmunoglobulina en infusión única y ácido acetilsalicílico, con respuesta rápida y favorable del cuadro cutáneo pero persistencia de la fiebre y reaparición del exantema a las 72 horas, por lo que se debió repetir la administración de inmunoglobulina. El ecocardiograma inicial revelaba dilatación de la arteria coronaria izquierda de 1,6 vez el diámetro del vaso adyacente.

Disseminated Strongyloides stercoralis: hyperinfection during medical immunosuppression.

Hyperinfection caused by Strongyloides stercoralis in iatrogenically immunosuppressed patients is becoming more frequently observed. Here, we review the relevant literature and present a recent case of hyperinfection syndrome of S stercoralis in a patient chronically treated with systemic corticosteroids and methotrexate for dermatomyositis. The patient was born in Guatemala but no history of Strongyloides infection was documented. Disseminated Strongyloides is often associated with the immunocompromised state and is commonly seen with cutaneous lesions, respiratory failure, and sepsis. In this patient, a protracted course of progressive muscle weakness and multiple hospital stays for respiratory distress led to acute respiratory failure, septic shock, and rapid physical decline. A few days preceding his death, the patient developed petechiae and multiple purpuric macules and patches over the abdomen and thighs. Histologic review of skin biopsy specimens demonstrated multiple intravascular and interstitial filariform larvae. Dermatologists should be aware of patient populations at risk for infection with S stercoralis and be able to make this diagnosis to initiate earlier treatment of hyperinfection and dissemination.

Correlates of readiness to change problem drinking among a sample of problem drinkers receiving care from an inner-city emergency department.

BACKGROUND: The high rate of alcohol use among emergency department (ED) patients makes the ED setting an obvious target for increased screening and interventions. However, interventions to change alcohol behavior may be applied inappropriately if a patient's motivation to change is not factored in. In this study, we identify correlates of readiness to change problem drinking among a sample of ED patients with problem drinking. METHOD: Cross-sectional study of 295 ED patients who scored positive for alcohol problems on the CAGE questionnaire (score > or = 1). Study measures include illicit drug use, exposure to violence, and having a primary care doctor as the main predictor variables and level of readiness to change problem drinking as the outcome measure. RESULTS: Participants were 64% African American, 30% Latino, and 80% male; 46% had less than a high school diploma; 85% were not married; 72% had no health insurance; and 85% had no primary care provider. Whereas 12% of patients were not ready to change their drinking behaviors, 47% and 41% were unsure and ready, respectively. Multiple linear regression analysis showed that only the use of illicit drugs significantly affected the likelihood of changing one's level of readiness-to-change problem drinking (P < .05). Female and married participants were also more likely to be ready to change their alcohol use behaviors. CONCLUSIONS: Recognizing that approximately half of ED patients with problem drinking are ambivalent to changing their behaviors supports further investigation into specific clinical interventions aimed at motivating such individuals along the continuum of readiness to change. Such interventions should also incorporate strategies for addressing the co-occurrence of illicit substance use.

Hipoplasia de cavidades izquierdas: 6 años de seguimiento en el Servicio de Cardiología del Hospital de Niños de La Plata / Hypoplastic left heart syndrome: a 6 year follow-up study at the cardiac surgery unit, Hospital de Niños de La Plata

Objetivos: Examinar la sobrevida, las causas de muerte, los factores de riesgo y la calidad de vida de niños con hipoplasia de cavidades izquierdas (HCI) con reparación quirúrgica en tres estadios: Norwood modificado, Glenn bidireccional y cirugía de Fontan. Material y métodos: Entre junio de 1997 y marzo de 2003 se intervinieron 60 pacientes por HIC. Estadio I: 60 pacientes, edad promedio 23 días, peso 2,9 kg, 37 varones y 23 niñas. Se realizó anastomosis subclaviopulmonar con prótesis de politetrafluoroetileno expandido (PTFE) de 3,5 mm en 46 pacientes y de 4 mm en 24. Tiempo promedio de circulación extracorpórea: 164 minutos y paro circulatorio: 70 minutos. Estadio II: 14 pacientes, edad promedio 11 meses, peso 7,3 kg, 6 mujeres y 8 varones. estadio III: 3 pacientes, edad promedio 42 meses, peso 15 kg. Resultados: La sobrevida inmediata del estadio I fue del 60 por ciento y la muerte alejada del 21 por ciento. En el estadio II hubo una muerte inmediata y ninguna alejada. El cateterismo cardíaco posprocedimiento de Glenn mostró estenosis de rama pulmonar en 3 pacientes y coartación de la aorta en 3. En el estadio III no se produjo ninguna muerte. Conclusiones: la cirugía inicial debe ser precoz antes del desarrollo de hipertensión pulmonar. Para evitar las muertes alejadas, la anastomosis de Glenn debe realizarse entre los 5 y los 6 meses. La edad mayor de 30 días en el momento de la cirugía Norwood, la presencia de patología asociada, una anastomosis de 4 mm, hiperlactacidemia y el peso menor de 2,5 kg se asociaron con mayor mortalidad, aunque sólo esta última variable tuvo significación estadística.